PATENT APPUCATION FEE DETERMINATION RECORD
Effective October 1 , 2001
Application or Docket Number
70 VJ" 36 f(>/^i6*fU-*-^^
CLAIMS AS FILED - PART I
1 TOTAL CLAIMS
2-1""
1 FOR
NUMBER FILED
NUMBER EXTRA
1 TOTAL CHARGEABLE CLAIMS
)j minus 20=
1 INDEPENDENT CLAIMS
jQ minus 3 =
★
7
1 MULTIPLE DEPENDENT CLAIM PRESENT
□
* If ttie difference In column 1 is less than zero, enter "0" in column 2
CLAIMS AS AMENDED - PART II
(Column 1)
(Column 2)
(Column 3)
<
IliJ
CLAIMS 1
REMAINING
AFTER
AMENDMENT
HIGHEST
NUMBER
PREVIOUSLY
PAID FOR
PRESENT
EXTRA
\^
Iz
Total
*
Minus
luj
S
Independent
Minus
l<
FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM □
(Column 1)
(Column 2)
(Column 3)
ENTB 1
CLAIMS
REMAINING
AFTER
AMENDMENT
HIGHEST
NUMBER
PREVIOUSLY
PAID FOR
PRESENT
EXTRA
S
Total
*
Minus
z
lU
s
Independent
*
Minus
<
FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM □
(Column 1)
CLAIMS
REMAINING
AFTER
AMENDMENT
(Column 2) (Column 3)
HIGHEST
NUMBER
PREVIOUSLY
PAID FOR
PRESENT
EXTRA
FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM
SMALL ENTITY
TYPE
OTHER THAN
OR SMALL ENTITY
* If the entry in column 1 Is less than the entry In column 2, write "0" in column 3.
** If the "Highest Number Previously Paid For" IN THIS SPACE is less than 20, enter "20."
***lf the "Highest Number Previously Paid For" IN THIS SPACE Is less than 3, enter "3."
The "Highest Number Previously Paid For" (Total or Independent) is the highest number
RATE
cczc
rth
RATE
rtt
BASIC FEE
370.00
OR
BASIC FEE
740.00
X$9=
OR
X$18=
X42=
Un
X84=
+140=
UH
+280=
TOTAL
OR
TOTAL
SMALL ENTITY
OR
OTHER THAN
SMALL ENTITY
RATE
ADDI-
TIONAL
FEE
RATE
ADDI-
TIONAL
FEE
Aij) y=
OR
X42=
OR
X84=
+140=
OR
+280=
TOTAL
ADDIT. FEE
OR
TOTAL
Ar\r»iT ccc
^UUI i. rtii
RATE
ADDI-
TIONAL
FEE
RATE
ADDI-
TIONAL
FEE
X$ 9=
OR
X$18=
X42=
OR
X84=
+140=
OR
+280=
TOTAL
ADDIT FEE
OR
TOTAL
ADDIT FEE
RATE
ADDI-
TIONAL
FEE
RATE
ADDI-
TIONAL
FEE
X$ 9=
OR
X$18=
X42=
OR
X84=
+140=
OR
+280=
TOTAL
ADDIT FEE
OR
TOTAL
ADDIT FEE
found in the appropriate box in column 1.
FORMPTO-875 (Rev. 8/01)
Patent and Trademark Office, U.S. DEPARTMENT OF COMMERCE